Speech and Language

DEVELOPMENTAL MILESTONES

Speech and Language development varies from one child to another. However, there is a typical progression for learning these skills. Milestones are identifiable skills that serve as a guide to typical development. Basic skills usually develop before more complex skills and there is a general age when most children attain each.

If your child is not demonstrating milestones within those general ages or if you have any questions regarding their skills, we recommend that you make an appointment for an initial assessment at TALK. A licensed Speech-Language Pathologist can determine whether treatment is needed and/or provide you with suggestions to encourage speech and language development.

 Download a pdf file of the developmental milestones.

SPEECH AND LANGUAGE DEFICITS

We treat a variety of deficits at TALK. Some children only have one of the issues described below, while other may have combinations with varying severity. The following provides a brief overview of the most common types of communication disorders targeted at TALK:

language Delay and/or Disorder

Receptive/Expressive Language Deficit

Autism Spectrum Disorder

Apraxia of Speech

Auditory Processing Disorder

Articulation Disorder

Phonological Disorder

Social/pragmatic disorders

Oral/Feeding Disorders

Voice disorders

Fluency / Stuttering

Literacy and writing delays

language Delay and/or Disorder

Language delays and disorders are the most common developmental problem among preschool children, affecting 5 -10% of preschool children. Child development research has shown that the first three years are critical for learning language. Numerous studies have identified that through early identification and appropriate treatment, children can develop to their full potential.

Speech and Language Delays are characterized by a typical development sequence, but at a slower rate. On the other hand, Speech and Language Disorders are characterized by abnormal speech or language development sequences.

Speech and/or language deficits can be identified and treated as young as 12 months of age.

Receptive/Expressive Language Deficit

It is estimated that between three and five percent of children have a receptive or expressive language disorder, or a mixture of both.

Children need to understand language before they can use language effectively. A receptive language deficit is characterized by a child who has difficulty understanding what is said to them. The symptoms vary between individuals, but generally problems with language comprehension begin before the age of four years. Very often a child with receptive language deficits will have difficulty remembering things. This memory deficit is only apparent in speech related tasks; non-verbal or non-linguistically based memory will be unimpaired. In most cases, the child with a receptive language problem also has an expressive language disorder, which means they have trouble using spoken language.

Expressive language disorder is characterized by having a limited vocabulary and grasp of grammar (especially with tense and time words). It is a general language impairment that puts the child below level for his/her age and onto the level of a younger or less linguistically developed individual. There may be a gap between their receptive (understanding, listening, and writing) functioning and their expressive functioning, meaning they have more difficulty speaking and writing than the average individual their age and general developmental level. Expressive language disorders affect work and school in many ways, and are usually treated by specific speech/language therapy, and usually cannot be expected to go away on their own.

Autism Spectrum DisordeR

Autism is a developmental disability that affects, often severely, a person’s ability to communicate and socially interact with others. It is four times more prevalent in males than females. Currently, autism is believed to affect 1 in every 68 children. The rate of people being diagnosed with autism has increased substantially over the past two decades. 

Autism is considered a spectrum disorder because the number and intensity of the symptoms people with autism display may vary widely. However, all people with autism demonstrate impairments in the following three areas: communication, social relationships, and restricted patterns of behavior. The spectrum ranges from those who are severely affected and dependent on others to those who are of above-average intelligence and independence, yet lacking in social communication skills.

Childhood Apraxia of Speech (CAS) is a deficit in the ability to plan the motor movements for speech and is considered an oral motor planning disorder. Children with CAS have difficulties transmitting their "speech message" from their brain to their mouths. Symptoms of CAS include consonant and vowel distortions, distorted sound substitutions, errors that are inconsistent in type and place, and prosodic errors (prosody refers to pitch, rate, and rhythmic features of speech). Some other behaviors seen in CAS include oral groping, perseverative errors, and increasing errors as the length of utterance increases.

Auditory processing is a term used to describe the process of your brain recognizing and interpreting the sounds around you. The human ear recognizes sound that is transferred into electrical information that can be interpreted by the brain. The "disorder" part of auditory processing disorder (APD) means that something is adversely affecting the processing or interpretation of the information. Children with APD often do not recognize subtle differences between sounds in words, even though the sounds themselves are loud and clear. For example, the request "Tell me how a chair and a couch are alike" may sound to a child with APD like "Tell me how a couch and a chair are alike." It can even be understood by the child as "Tell me how a cow and a hair are alike." These issues are more likely to occur when a person with APD is in a noisy environment or when he or she is listening to complex information. APD goes by many other names: central auditory processing disorder (CAPD), auditory perception problem, auditory comprehension deficit, central auditory dysfunction, central deafness, and so-called "word deafness."

Articulation refers to the manner in which a child produces a sound and the placement of the articulators (tongue, lips, palate, jaw, and teeth). Articulation errors occur when a child attempts to produce a phoneme (a speech sound) with an incorrect placement, resulting in a disotored or completely different sound. Traditionally, it is thought that some articulation errors are developmental in nature and that children may not be ready to address them in therapy until a specific age (typically 7 or 8). However, current research suggests beginning articulation treatment with the most difficult sounds is just as effective, and often more effective, than following the developmental norms for articulation. Research is now finding that the earlier therapy begins, the more successful it will be.

Phonological processes are methods used by children to simplify words as they are still developing. For example, a young child may call a "cat" a "tat." This actually allows children to express language earlier than their ability to produce the correct sounds. These processes are expected to fade as a child's ability to form the correct sounds improves. When these processes persist, we refer to them as phonology disorders. Children with phonology disorders are frequently unintelligible; often, their parents are the only ones who can understand them, and even they, at times, have difficulties. Children with these disorders are at high risk for later reading and learning disabilities, but can be treated with speech therapy.

Pragmatics refers to language in social contexts, such as knowing what to say, how to say it, when to say it - and how to "be" with other people. Children with pragmatic difficulties have trouble using language socially in ways that are appropriate or typical of children their age. They often do not understand that we take turns in a conversation; they will "talk over you" at times, or at other times, respond to what you say with inappropriate silences, or in a voice that is too quiet. They may interrupt excessively and talk irrelevantly or about things the in which the listener shows no interest. Their communicative behavior often appears rude and inconsiderate. Children with social communication/pragmatic deficits may have difficulty playing with other children, whether it be one-on-one or in a group/classroom setting, and may also have challenges with perspective-taking, demonstrating social problem solving skills, or difficulty understanding or using humor, among others. Social skill intervention is often targeted in small group settings with peers, and is relevant to the child’s everyday routine for immediate carry-over and generalization.

Oral Sensory or Oral Placement deficits may affect speech and/or feeding skills. Signs of oral placement deficits include:

• Hyper-sensitivity to touch: These children are resistant to textures of foods or brushing teeth.

• Hypo-sensitivity to touch: These children seek out input by mouthing objects

• Excess saliva or drooling: These children may exhibit jaw, tongue or lip muscle weakness or decreased sensory awareness that make saliva management difficult.

Oral Placement programs are designed to improve awareness, stability, and movement. Additionally, coordination and sequencing of articulators are also targeted. Specific oral postures paired with sound and word production typically show the best results. Our therapists employ a combination approach using muscle- based therapy, such as Talk Tools and the PROMPT tactile cueing system, if deemed appropriate depending on the diagnosis and individual client needs.

Oral motor deficits, oral sensitivity, and motor coordination can also contribute to feeding disorders. All children have non-preferred foods, but when their pickiness begins to affect their health or their ability to eat a variety of foods, feeding therapy can be employed to increase the range of foods they will accept through a specific and sequential process that allows the children to explore different textures, tastes, and food types.

Voice disorders refer to a person's quality of voice such as breathy, hoarse, overly-loud, or harsh vocal patterns. Most , but not all, changes in the voice result from a medical disorder. Failure to seek a physician’s care can lead to hoarseness and more serious problems. The most common voice disorders in children are laryngitis, vocal cord lesions, poor speaking technique and vocal cord paralysis.

Fluency is a communication disorder involving disruptions in the forward flow of speech. These speech disfluencies are moments when a child has difficulty "getting his words out." As a result, he/she may repeat parts of word (li-li-like this), stretch out sounds (llllike this), or experience a complete blockage of speech when no sound comes out at all (l---ike this).

Many times, young children are not aware of their speech disruptions at all, they simply repeat parts of words or prolong sounds until they are able to continue speaking. Other times, children become frustrated, frightened, or confused because of their speaking difficulties. This may lead them to try to do different things to "fix" their speech, such as tensing the muscles in their mouth in an attempt to "push" words out, tapping their mouth with their hand, or simply giving up and not talking at all. Although all of these behaviors can be considered part of the child’s overall stuttering pattern, they vary from child to child.

All children exhibit disfluencies in their speech — making mistakes is a normal part of learning to talk. Furthermore, some types of disfluencies are actually a normal part of the communication process. We all occasionally produce interjections, such as "um" or "uh", while we are thinking about what we want to say. Similarly, we sometimes make changes in what we want to say, and then revise our speech accordingly (e.g., "I want- I need that"). These examples of "normal" or "typical" types of disfluencies are different from stuttering, which involves a seemingly involuntary interruption in speech or a moment when the child knows what she wants to say but has difficulty saying it. If your child's ability is being negatively affected by dysfluencies it is recommended that they be evaluated by a Speech Language Pathologist and that intervention begins as soon as possible.

Research indicates that 17-20% of our nation’s children experience substantial difficulties in learning to read, and that more than a third of students in fourth grade (and nearly 70% in some low-income urban schools) read below the basic level. Children who are not fluent readers by fourth grade are likely to continue struggling with reading into adulthood, making early identification and intervention of reading problems essential to a child’s success in both school and society. Spoken language provides the foundation for the development of reading and writing. In fact, spoken and written language share a reciprocal relationship, building on each other to result in general language and literacy competence. Children who have problems with spoken or verbal language frequently experience difficulties learning to read and write, and children with reading and writing problems often experience difficulties using language to communicate, think and learn. Similarly, intervention targeting verbal language often results in growth in written language.